is the serious infectious disease of airways caused by characteristic bacteria (Bordetella pertussis). Whooping cough is very infectious: infection probability at contact is about 90%. For small children, is younger than two years, – it is especially dangerous.
Children of preschool age are ill it generally. The incubation interval is from about 7 to 14 days. It is transferred in the airborne way. From the first to the twenty fifth day of a disease of the patient it is infectious. Timely treatment by antibiotics considerably reduces duration of the infectious period.
Around the world whooping cough is endemic. In a certain area the arisen disease becomes epidemic which lasts about from two to four years. More than a half of cases of diseases is the share of children up to two years. The organism on the first disease does not develop immunity for the rest of life though in case of a recurrent disease the disease proceeds easily, sometimes does not even differ.
Whooping cough symptoms
• The first (catarrhal) stage (reminding common cold and lasting from 10 days to two weeks); cold; sneezing; moderate cough; general feeling of feeling sick.
• The second (paroxysmal) stage (lasting four - six weeks): attacks of the severe cough sometimes accompanied with the characteristic "barking" sounds when air is sharply inhaled at the end of a fit of coughing; protruding eyes and the blown-up neck veins; a cyanotic shade of skin during a fit of coughing because of a lack of oxygen; the vomiting caused by efforts to remove a dense phlegm; spasms (seldom).
• The third stage (recovery period): fits of coughing become moderate and less frequent.
Clinical manifestations of the catarrhal period of whooping cough.
The clinic of the catarrhal period of whooping cough is characterized by gradual development and existence of catarrhal and all-infectious syndromes. However the all-infectious syndrome is noted no more than at a half of patients and it consists of the short-term subfebrile body temperature (no more than 3 — 4 days) and an insignificant indisposition. The main symptom of the catarrhal period — cough which is characterized by gradual increase of intensity and frequency day by day. The carried-out symptomatic therapy of effect does not render. At the same time data of percussion and auskultativny inspection of lungs do not reveal any changes.
Other catarrhal phenomena (serous discharges from a nose, hyperaemia of a back wall of a throat) are expressed poorly at 1/3 patients and are stopped within 3 — 5 days.
The catarrhal period on average proceeds 10 — 14 days. At immunized it can be extended with vaccine AKDS of patients, and at children of early age — to be shortened.
Clinic of the convulsive period of whooping cough.
The convulsive period of whooping cough has bright clinical manifestations. In this period the cough gains paroxysmal character. To emergence of a fit of coughing as children of school age note, a peculiar aura in the form of irritation and tickling in a throat, sneezing, a general malaise, the uncertain squeezing pains in a thorax can precede. The fit of coughing is characterized by existence of a number of the expiratory tussive pushes which are quickly replacing each other from time to time interrupted by the whistling breath — to reprises. The fit of coughing proceeds up to 5 minutes and comes to an end with discharge of a viscous phlegm or vomiting, or vomiting at children of the first year of life. Frequency of developing of characteristic cough varies from 5 to 40 — 50 attacks a day. Fits of coughing arise in a dream more often, can be provoked by feeding, physical activity.
The outward of the patient during an attack is characteristic: the face is hyperemic, bloated, from eyes tears are allocated, skin veins of the person, the heads, necks bulk up. In the beginning appears perioral, and then diffuse cyanosis of the person, mucous, language is possible. Tongue during an attack is extremely put out, on a bridle the sore is formed. At the time of a fit of coughing, hemorrhages in scleras, nasal bleedings, petechias on a face and an upper part of a trunk can develop.
Attacks of spasmodic sneezing can be equivalents of paroxysmal cough, children of early age have attacks of a syncopal apnoea. More senior children during a fit of coughing have spasmodic an apnoea as a result of a laryngospasm and smooth muscles of airways.
Body temperature in the period of convulsive cough does not increase.
At a research of respiratory organs the tympanic shade of a percussion sound is found (almost in 90% of patients). Auscultation of lungs reveals dry and damp large-bubbling rattles which can disappear completely after a fit of coughing against the background of rigid breath and renew after a while.
The cardiovascular system practically always joins in pathological process what confirm is long the remaining tachycardias, an arterial and venous hypertension, increase in the sizes of heart to the right, a priglushennost and dullness of warm tones.
Defeat of a cardiovascular system, metabolic disorders as a result of a hypoxia lead to development of pallor of skin, cyanosis of lips and a Crocq's disease, a cold snap of extremities.
Changes from nervous system are various and are defined, in particular, by degree of oxygen insufficiency and depth of circulator disorders.
The first symptoms of the beginning pertussoid encephalopathy are the general concern which is replaced by a hypodynamia a sleep disorder at night and the increased drowsiness in the afternoon, increase in tendon jerks, convulsive readiness. Spasms, consciousness disturbances, a hemiparesis demonstrate more rough damage of nervous system.
Encephalopathy develops mainly at patients with an adverse premorbid background (pre-natal damage of central nervous system, a birth trauma, etc.), at a whooping cough combination to viral infections (flu, an adenoviral infection, CMVI, etc.). Duration of the period of convulsive cough varies of 1 — 1.5 week at immunized children, up to 4 — 6 and even 8 weeks at not vaccinated.
Whooping cough convalescence period.
Duration of the period of a convalescence is 2 — 3 weeks.
Cough gradually loses the paroxysmal character. Fits of coughing in this period can be provoked by physical or emotional activity.
After recovery at children the tendency to a recurrence of spasmodic cough at development of acute respiratory diseases remains.
Basic diagnostic characters of a typiform of whooping cough. It is possible to mark out the following basic diagnostic characters of a typiform of whooping cough:
• The instruction in an epidanamneza on contact with is long the coughing child.
• The dry accruing cough at normal or subfebrile body temperature, the mild and quickly stopped catarrhal phenomena.
• Lack of effect of the carried-out therapy in the catarrhal period.
• Appearance of paroxysmal cough with reprises, 1 — 2 week later from the beginning of a disease.
• Discharge of a dense viscous phlegm or vomiting after a fit of coughing.
• Lack of continuous changes from lungs in the period of spasmodic cough.
• Possible dizritmiya of breath and attacks of an apnoea.
• In peripheral blood: a leukocytosis, a lymphocytosis, SOE below normal indicators or norm.
• Discharge of a pertussoid stick at bacteriological inspection by method of tussive plates.
• Increase of a caption of antipertussoid antibodies in the patient's blood at serological inspection by 4 times.
Diagnosis of whooping cough
Specific diagnosis of whooping cough are made by bacteriological methods: activator discharge from a phlegm and smears mucous upper airways (bakposev on nutrient medium). The Koklyushevy stick is sown on the Borde-Zhangu environment.
Serological diagnostics by means of RA, RSK, RNGA is made for confirmation of the clinical diagnosis as reactions become positive not earlier than the second week of the convulsive period of a disease (and in certain cases can yield negative take and in later terms).
Nonspecific diagnostic techniques note symptoms of an infection (a lymphocytic leukocytosis in blood), slight increase of SOE is characteristic.
At development of complications from respiratory organs the consultation of the pulmonologist and carrying out a X-ray analysis of lungs is recommended to patients with whooping cough.
Treatment of whooping cough
1. Causal treatment is directed to destruction of the activator. In this disease the antibiotics directed against the specific causative agent of whooping cough (sumamed), but before obtaining bacteriological results are appointed, prescribing of shirokospektorny drugs, with their change on necessary is possible further. Causal treatment is appointed throughout the catarrhal period, on average 2 weeks.
2. Pathogenetic and symptomatic:
- for stopping of a brnkhospazm and a bronkhoobstruktion, appoint Euphyllinum and also inhalations with berodualy and beroteky
- the means oppressing a tussive reflex (to children up to 3 years – neokodion, kodipront; to a stursha of 3 years – stoptussin, sinekod,
- the mucolytic means improving phlegm otkhozhdeniye – inhalation with drugs
- drugs for restoration of a hemodynamics and exchange processes in central nervous system - piracetam
- immune drugs: immunomodulators and immunostimulators
- drugs of metabolic rehabilitation, fill up reserve abilities of an organism – vitamin complexes
At heavier clinical manifestations of patients hospitalize, the hospital adds to the carried-out treatment: oxygenotherapy, glucocorticoids, use of antipertussoid anti-toxic immunoglobulin human is possible.
Prevention of whooping cough
Frequent washing of hands and use of masks will help to reduce risk of infection if someone from house is sick with whooping cough. Also try not to touch a nose or to a mouth - so you are protected from bacteria which, perhaps, got to you on hands during contact with the patient.
For children it is necessary to adhere to the recommended schedule of inoculations for AKDS (diphtheria, tetanus, whooping cough). Inoculations are carried out at the age of 2 months, 4 months, 6 months, 15-18 months and 4-6 years for absolute immunity; according to data of the American academy of pediatrics.
In 2005 the U.S. Government approved the vaccine Tdap * instead of ADS for the first revaccination from whooping cough of children aged from 10 up to 18 years. The advisory committee on immunizations (ACIP) and the Center for control and prevention of diseases recommends one dose of Tdap instead of one dose of ADS
For adult 19-64 years ACIP recommends one dose of Tdap;
If you never received Tdap, one dose of Tdap has to replace one dose of vaccine ADS if the last use of stolbnyaksoderzhashchy vaccine was at least 10 years ago.
The adults who are in close contact with babies at the age of 12 months or are younger which did not receive Tdap earlier, have to undergo vaccination of Tdap; the shortest interval of 2 years from the moment of the last revaccination.
The medical personnel staying in direct contact with the patient and which did not receive Tdap earlier have to undergo vaccination of Tdap; the shortest interval of 2 years from the moment of the last revaccination.
Whooping cough complications
Especially hard, with considerable lethality, whooping cough proceeds at children of the first months of life; at babies attacks of an apnoea (apnoea), pneumonia (pneumonia), atelectases (25%), spasms (3%), encephalopathy (1%) are often observed.
Damage of lungs (bronchial pneumonia), especially at chest age is dangerous (probability of 15%).
Besides, a serious complication is encephalopathy, changes in a brain which owing to developing of spasms can lead to death or leave behind permanent damages, deafness or epileptic attacks.
Mortality is high in developing countries. In the developed countries the whooping cough mortality and its complications reaches 0.04%.